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Abbey Alkon, PhD; Janice L. Genevro, PhD; Jeanne M. Tschann, PhD; Pamela Kaiser, PhD; David R. Ragland, PhD; W. Thomas Boyce, MD, MPH

Arch Pediatr Adolesc Med. 1999;153:1248-1254.

Objectives  (1) To describe the pattern of injury in preschool-aged children in 4 child care centers as compared with the results of other studies; (2) to compare injury rates by sex, age, and child care center; and (3) to examine environmental and child factors contributing to injury severity.

Design  A 2-year cohort study of 362 preschool-aged children attending 4 urban child care centers. Teachers completed standardized injury forms on the type of injury, body location, site of injury, and contributing factors.

Results  During the 2 years of the study, 1886 injuries were reported. The mean and median child injury rate was 6 and 4 injuries per 2000 exposure hours (equivalent to 1 full-time child care year), respectively. The majority of injuries (87%) were minor, occurred during free play (81%) and on the playground (74%), and were precipitated by child-related factors (59%), such as being pushed. Boys had significantly higher median injury rates than girls. Age-adjusted injury rates for each child care center were significantly different by center (F₃ = 61, P<.001). While moderate to severe injuries were more often precipitated by combinations of child and environmental factors (²₄ = 20, P<.001), minor injuries were usually precipitated by child-related factors.

Conclusions  Injury data from child care centers are important for identifying common risk factors for frequent or severe injury events and for designing injury prevention programs. More research is needed to identify factors contributing to injuries, such as children's behavior and the child care centers' physical and socioemotional environments.

From the Department of Family Health Care Nursing (Dr Alkon) and the Departments of Pediatrics and Psychiatry (Dr Tschann), University of California, San Francisco; Department of Population and Health Sciences, Johns Hopkins University School of Public Health, Baltimore, Md (Dr Genevro); and the School of Public Health, University of California, Berkeley (Drs Ragland and Boyce). Dr Kaiser is in private practice in Menlo Park, Calif.

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